The Pivot Nurse in Oncology (PNO) role appears to make a substantial difference in care for patients being treated for advanced lung cancer, according to a study presented at the European Lung Cancer Congress (ELCC) 2018.
As treatment continues to advance in the lung cancer space, associated toxicities, more complex care processes and decreases in patients’ quality of life are also higher. To address these issues and improve care with better patient-physician interactions and resolve underlying problems that lead to dissatisfaction, health care organizations around the world have implemented a variety of strategies.
The PNO role was introduced into oncology clinics in Canada in 2001, which was “enshrined by the Ministry of Health and Social Services of Quebec in 2005 as part of its Fight Against Cancer campaign,” study author Elie Kassouf, hematologist and medical oncologist at Centre Hospitalier de Lanaudière (CHDL) in Saint-Charles-Borromée, Canada, said in a press release.
“In over 15 years of existence, however, very little data has been collected about its impact on patients’ lives. Our study’s main goal was therefore to determine whether the continuity of nursing care has tangible benefits to patients treated for lung cancer, as compared to the usual standard of care without a coordinating nurse.”
The researchers selected 65 patients with advanced lung cancer from the outpatient admissions list at the Notre Dame du CHUM, in Montreal, Canada, who were 3 months in to their treatment regimen. Patients were divided in to 2 groups: the continuity of care cohort, where patients were followed by a PNO (n=53); and the usual care cohort, who received standard care from the oncology clinic staff (n=12).
“At the CHUM, patients who enjoy continuity of care have a treating pivot nurse in addition to their treating physician. Each pivot nurse cares for 50 to 60 patients, who all have his or her direct phone number,” Kassouf explained. “The PNO has the patients’ files and can take care of scheduling follow-up appointments with their physician as soon as they receive new test results. If a patient calls to report worrying symptoms, the nurse will also speak directly to their doctor, who may then see that person on short notice without the latter having to go through the regular emergency system.”
To determine the efficacy of this service, both groups completed questionnaires on patient satisfaction and quality of life – which included 4 dimensions of the patient-physician relationship: interpersonal skills, empathy, information exchange, and quality of time. Patients also answered questions assessing their understanding of their health status and disease. In addition, the continuity of care cohort filled out a specific survey on the role of their PNO.
Both questionnaire analyses showed superior outcomes among patients in the continuity of care cohort regarding information exchange, empathy, and quality of life (P < .001), as well as physical, social, family, emotional, and functional well-being.
In conjunction, these differences translated into better satisfaction when compared with the total scores of both cohorts (P < .0001).
“The score difference we saw between the 2 cohorts was huge across the board: not because the usual care group scored poorly – their results were similar to those found in other studies based on the same questionnaire – but because the continuous care cohort produced exceptionally high scores,” said Kassouf.
Similarly, the additional surveys revealed an adequate fulfilment of the PNO role as regarded by the participants, and a large majority of patients stated that they had a better understanding of the course of their disease and treatment side-effects, and that the presence of their pivot nurse gave them more strength in their fight against cancer. “The only concerns that many people felt were not sufficiently addressed by their PNO were those pertaining to intimacy,” said Kassouf.
Although these results may be hard to generalize because of the sample size – which was substantial because the PNO program has been around for 15 years, and the vast majority of patients in Quebec today have access to a pivot nurse – Kassouf noted that the differences found between the 2 groups were so wide that the results are statistically significant nonetheless.
“Despite the small number of patients involved, which means we must be cautious with the results, this work shows a clear tendency of continuity of care improving when there is an established role similar to that of the pivot nurse on a patient’s medical team,” Anja Kröner, a PhD-prepared nurse in oncology and member of the management team at the Comprehensive Cancer Centre in Zurich, Switzerland, commented on the study results in the press release.
She noted that similar measures have been taken in European institutions; for example, several clinics in Germany found it was beneficial to assign a case manager to patients with cancer.
Kröner attributed these needs to growing complexity of cancer treatment. “Parallel to this, we see patients with financial or social burdens who are at particular risk for low adherence to treatment,” she said. “In oral therapy, for example, they have pills to take on their own at home that cause severe sideeffects. The routine care process is not very good at detecting individuals who stop taking their medication without telling their doctor about it. That is where pivot nurses can make a real difference.”
However, while researchers continue to address these limitations in care, she recommends for patients to not only be satisfied with their doctors, but with the healthcare team as a whole.
“It would be interesting to take the research further by framing patient satisfaction more broadly, as well as considering other outcomes alongside quality of life, such as patients’ ability to carry their own weight, or to work, throughout the process,” she added. “In light of the financial pressure faced by many healthcare systems today, it would also be worth exploring whether pivot nurses can reduce the cost of cancer, as another study has already suggested.”
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